Can post-tonsillectomy pain be reduced by topical bupivacaine? Double blind controlled trial

Abstract

A double blind controlled prospective trial investigated the analgesic effect of topical Bupivacaine in 15 adult patients undergoing bilateral tonsillectomy. Each patient had one tonsillar fossa exposed to Bupivacaine 0.5 per cent solution and the other to normal saline. When visited four to six hours post-operatively, 12 out of 15 patients (80 per cent) stated that the Bupivacaine exposed side to be more uncomfortable than the saline exposed side. On the first post-operative mornning 9 out of 15 patients (60 per cent) confirmed the same. The remaining patients were unable to detect a significant difference and no patient found the Bupivacaine side to be more comfortable.These results suggest that topical Bupivacaine 0.5 per cent solution has no place in providing post-operative analgesia in adult tonsillectomy.

Does topical lidocaine with adrenaline have an effect on morbidity in pediatric tonsillectomy?

“…The post-operative analgesic effect of different agents appears to be inconsistent in different studies. Violaris and Tuffin [19] did not find any benefit of topical bupivacaine in decreasing post-operative analgesia in adult tonsillectomy. On the other hand, Hung et al [3] found that topical bupivacaine had some pain relieving effect in children following tonsillectomy.…”

A Prospective Randomized Double‐Blind Trial of Fibrin Glue for Pain and Bleeding After Tonsillectomy

“…Numerous systemically administered pain medications have been compared with controversial results 8‐12 . Studies of preoperative or postoperative infiltration of the peritonsillar tissue with local anesthetics or steroids are also inconclusive 13‐22 . Similarly, comparisons of varied surgical techniques such as bipolar or monopolar dissection, 23‐26 laser tonsillectomy, 27,28 or obliteration of the tonsillar fossa by suturing the faucial pillars 6,29 have been equivocal.…”

The Effect of Regional Nerve Blocks on Immediate Post Tonsillectomy Pain in Adult Patients: A Randomised Controlled Trial

“…Bene®t has been demonstrated by some, 5±7 no bene-®t by others 8,9 and, indeed, one has suggested that topical application is actually counterproductive. 10 The tonsillar bed derives its nerve supply from a number of sources, known collectively as the`circulus tonsillaris'. 11 The nerves involved are: 1.…”